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NAN <br /> NON-HAZARDOUS 1 Generators US EPA ID No Mandest Doc No 2 Page t ' <br /> WASTE MANIFEST n a 00001 1 of 1 `r <br /> 3 Generators Name and Mailing Address <br /> cheveron lode <br /> hWV 12 <br /> 4 Generators Phone( g 0 9) 467-1006 h n t l m Cr <br /> 5 Transporter 7 Company Name 6 US EPA ID Number A Transporters Phone <br /> INVIRO TECT <br /> N A 434-0211 .w <br /> 7 Transporter 2 Company Name 8 US EPA ID Number B Transporters Phone <br /> F� <br /> 9 Designated Facility Name and Site Address 10 US EPA ID Number C Facility s Phone <br /> t INVIRO TEC <br /> 2480 ATHENS AVE . <br /> LINCOLN , CA a <br /> 11 Waste Shipping Name and Description 12 Containers 13 14 - <br /> Total Unit i <br /> No Type Quantity Wt/Vol ; <br /> a r <br /> rV non haz waste liquid nos <br /> waste water 7 <br /> G b , <br /> - E ' <br /> N <br /> R k <br /> A c <br /> T <br /> t R s <br /> d r <br /> i <br /> D Ade,onal Descriptions for Va,erials Listed Above E Hand';ng Codes for VVas,Es Listed Above <br /> purge water <br /> 15 Specaal"anal ng Instruc,ions and Additioral Inio ma,ion <br /> emergency g y // TROY 916-826-3803 <br /> 16 GENERATOR S CERTIFICATION ce; y ',e�-e ms's dr-cr,ed aooN e on,�,s r a-,es a e not s,-b ect io'eceral reg,dal o-s rc eaor•,ng proper d,sp^ al of Hazerdc js%vas e <br /> Pnrted(Tt aed Name � / r � Signa. � �I 1 _ Pion 7 Dav )ear <br /> 1 J <br /> l G CCD, <br /> T 17 Tran=porer 1 Ackno le,.^ye rert of Receipt of va e'a <br /> A P in „ Jame <br /> N ^ Sigra' 41091114109111D.3v tear <br /> � <br /> P -�---�_. .� �� Uig <br /> O 8 Transponer 2 Acenowleoeemcnt cf Receipt of Ma Cr a's <br /> R <br /> T F- <br /> Printetf/Tvpeo Name <br /> E Siona,ure 1,40n1h Day Year <br /> R <br /> 19 Discreparcy Endicetion Space <br /> F <br /> A <br /> C <br /> I ' <br /> L 20 Fac0ity Cianer or Operator Ce^fica,ion et receipt c` %as,e materials cotereo by mandest except as notcd�n item 19 <br /> I <br /> PantedTvped Name C r Man DaY wear <br /> P anted by J J KELLE R B AS SOCSATES INC <br /> Neenah wt sass?ops 12-BLS-05 Rev 12/98 ' <br /> ORIGINAL - RETURN TO GENERATOR <br />